Invoice Ophthalmologist in Australia Sydney –Free Word Template Download with AI
Level 12, 100 George Street
Sydney, NSW 2000
Australia
Phone: +61 2 9123 4567
Email: [email protected]
ABN: 12 345 678 901
INVOICE
Invoice Number: INV-2023-8942
Date Issued: 24 October 2023
Due Date: 24 November 2023
Service Location: Australia Sydney
Bill To:
Patient Name: Mr. James Anderson
Address: 45 Harbour View Drive, Bondi Beach, NSW 2026, Australia
Medicare Number: 1234 567890 1234
Private Health Fund: Bupa Private Health
Policy Number: BUP-99887766
This Invoice represents the professional fees for ophthalmological services rendered by a registered Ophthalmologist at our clinic located in Australia Sydney. The services detailed below were provided in accordance with the Medical Benefits Schedule (MBS) and private practice standards applicable in New South Wales.
As a specialist Ophthalmologist practicing in Australia Sydney, we are dedicated to providing comprehensive eye care, ranging from routine examinations to complex surgical interventions. This document serves as an official request for payment for the balance remaining after Medicare rebates and private health fund contributions have been accounted for.
| Description of Services | MBS Item No. | Medicare Rebate | Professional Fee |
|---|---|---|---|
|
Comprehensive Ophthalmological Examination Detailed assessment of visual acuity, intraocular pressure, and retinal health performed by a specialist Ophthalmologist in Australia Sydney. Includes slit-lamp biomicroscopy and dilated fundus examination. |
23 | $85.00 | $250.00 |
|
Optical Coherence Tomography (OCT) Advanced imaging of the retina and optic nerve head to detect early signs of glaucoma and macular degeneration. This diagnostic procedure is standard for specialist care in Australia Sydney. |
73310 | $120.50 | $350.00 |
|
Prescription for Corrective Lenses Provision of a detailed prescription following the examination by the Ophthalmologist. |
N/A | $0.00 | $50.00 |
|
Consultation for Cataract Assessment Evaluation of lens opacity and discussion of surgical options. This consultation is part of the pre-operative planning process managed by our Ophthalmologist team in Australia Sydney. |
23 | $85.00 | $250.00 |
| Total Professional Fees: | $900.00 |
| Less: Medicare Rebate (Claimed): | -$290.50 |
| Less: Private Health Fund Contribution: | -$150.00 |
| Total Amount Due (Out-of-Pocket): | $459.50 |
Payment Instructions
Please remit payment for this Invoice by the due date indicated above. We accept payments via Bank Transfer, Credit Card (Visa/Mastercard), or EFTPOS at our clinic in Australia Sydney.
Bank Transfer Details:
Bank: Commonwealth Bank of Australia
Account Name: Sydney Vision Specialists Pty Ltd
BSB: 062-000
Account Number: 12345678
Reference: INV-2023-8942
Important Information
This Invoice is issued in accordance with the Privacy Act 1988 (Cth) and the Health Records and Information Privacy Act 2002 (NSW). Your personal health information is handled with the utmost confidentiality by our Ophthalmologist and administrative staff.
If you have any questions regarding the charges on this Invoice or the services provided by your Ophthalmologist in Australia Sydney, please contact our billing department at +61 2 9123 4567. We are committed to ensuring transparency in all financial matters related to your eye care.
Please note that this Invoice reflects the gap payment between the Medicare Benefits Schedule (MBS) rebate and the professional fee charged by the Ophthalmologist. Private health fund rebates are estimated based on your provided policy details and may vary.
Thank you for choosing Sydney Vision Specialists for your ophthalmological needs. We are proud to serve the community of Australia Sydney with world-class eye care services.
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